Knee arthroplasty and preservation of the quadriceps mechanism

• US 7,806,897 B1
• Filed: 06/30/2005
• Issued: 10/05/2010
• Est. Priority Date: 01/14/2000
• Status: Expired due to Fees

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: MarcTec LLC
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US11/171,700
• Time in Patent Office: 1,923 Days
• Field of Search: 606/79, 606/80, 606/82, 606/86, 606/88, 606/87, 606/89, 606/86.R, 606/86.A, 606/300, 128/898, 623/20.14, 623/20.15, 623/20.16
• US Class Current: 606/86.00R
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/158 Cutting patella
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1717 for applying intramedullary nails or pins
• CPC Class Codes: A61B 17/1721 for applying pins along or parallel to the axis of the femoral neck
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/809 with bone-penetrating elements, e.g. blades or prongs bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 for the knee
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61B 2017/564 : Methods for bone or joint treatment
• CPC Class Codes: A61B 2034/102 : Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 : Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 : Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2055 : Optical tracking systems
• CPC Class Codes: A61B 2046/201 : for extremities, e.g. having collection pouch
• CPC Class Codes: A61B 2046/205 : Adhesive drapes
• CPC Class Codes: A61B 2046/236 : with means for collecting drain fluid, e.g. drain tubes
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/366 : using projection of images directly onto the body
• CPC Class Codes: A61B 2090/376 : using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• CPC Class Codes: A61B 34/10 : Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 42/00 : Surgical gloves; Finger-stalls specially adapted for surgery; Devices for handling or treatment thereof
• CPC Class Codes: A61B 46/00 : Surgical drapes
• CPC Class Codes: A61B 90/13 : guided by light, e.g. laser pointers
• CPC Class Codes: A61B 90/30 : Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61F 2/0077 : Special surfaces of prostheses, e.g. for improving ingrowth A61F2/30767 takes precedence
• CPC Class Codes: A61F 2/30721 : Accessories
• CPC Class Codes: A61F 2/30724 : Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30771 : applied in original prostheses, e.g. holes or grooves
• CPC Class Codes: A61F 2/34 : Acetabular cups
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/3836 : Special connection between upper and lower leg, e.g. constrained
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3868 : with sliding tibial bearing
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/461 : of knees
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/2817 : Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2825 : Femur
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/30326 : differing in height or in length
• CPC Class Codes: A61F 2002/30331 : made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2002/30364 : Rotation about the common longitudinal axis
• CPC Class Codes: A61F 2002/30387 : Dovetail connection
• CPC Class Codes: A61F 2002/30398 : Sliding
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30761 : Support means for artificial cartilage, e.g. cartilage defect covering membranes
• CPC Class Codes: A61F 2002/30883 : dovetail-shaped
• CPC Class Codes: A61F 2002/30892 : parallel
• CPC Class Codes: A61F 2002/3092 : having an open-celled or open-pored structure
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30975 : made of two halves
• CPC Class Codes: A61F 2002/3401 : with radial apertures, e.g. radial bores for receiving fixation screws
• CPC Class Codes: A61F 2002/3403 : Polar aperture
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4677 : using a guide wire
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2250/0037 : differing in height or in length
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00365 : Proteins; Polypeptides; Degradation products thereof
• CPC Class Codes: A61G 13/0045 : specially adapted for hand or wrist surgeries
• CPC Class Codes: A61G 13/0054 : specially adapted for back or spinal surgeries
• CPC Class Codes: A61G 13/0063 : specially adapted for knee surgeries
• CPC Class Codes: A61G 13/0072 : specially adapted for shoulder surgeries
• CPC Class Codes: A61G 13/0081 : specially adapted for hip surgeries
• CPC Class Codes: A61G 13/1245 : Knees, upper or lower legs
• CPC Class Codes: A61G 13/125 : Ankles or feet

Abstract

A method is provided for the preparation and performance of a total knee arthroplasty. The method includes making a primary incision near the knee joint of a leg of a patient. The incision is sized or located preserving a quadriceps mechanism in the leg of the patient. The method also includes resecting medial and lateral condyles of the femur of the leg to create at least one femoral cut surface and moving a femoral component of a total knee implant through the primary incision. The method further includes positioning the femoral component with respect to the at least one femoral cut surface.

Claims

1. A method of performing and preparations for a knee arthroplasty, comprising:

making a single primary incision near the knee joint of a leg of a patient, the incision sized or located such that a quadriceps mechanism in the leg of the patient is substantially preserved;

resecting a surface of at least one of the medial and lateral condyles;

resecting a surface of the trochlear groove of the femur of the leg;

moving a femoral component of a knee implant having an articulating surface operative to replace substantially the entire articulating surfaces of the trochlear groove and at least one of the medial and lateral condyles, through the primary incision; and

positioning the femoral component with respect to the at least one femoral resected surface.

2. The method according to claim 1, further comprising the step of resecting a tibia of the leg to create at least one tibial cut surface, moving a tibial component of the knee implant through the primary incision, and positioning the tibial component with respect to the at least one tibial cut surface.

3. The method according to claim 2, further comprising the step of displacing a patella of the leg to an offset position so that the inner side of the patella remains in a position facing the femur.

4. The method according to claim 3, further comprising the step of resecting a portion of the patella to create a patellar cut surface, moving a patellar component of the knee implant through the primary incision, and positioning the patellar component with respect to the patellar cut surface.

5. The method according to claim 4, wherein the step of resecting the patella is performed before resecting the tibia and femur.

6. The method according to claim 1, wherein the primary incision is made when the knee joint of the leg is flexed.

7. The method according to claim 6, wherein a lower portion of the leg is suspended relative to an upper portion of the leg.

8. The method according to claim 1, further comprising moving a guide member through the primary incision and positioning the guide member against the femur, the guide member having a guide surface.

9. The method according to claim 7, wherein the resection step includes positioning a cutting tool in association with the guide surface of the guide member.

10. The method according to claim 9, further comprising the steps of removing the guide member from the femur prior to completing the cut of the medial and lateral condyles and the trochlear groove and continuing the cut of the medial and lateral condyles while guiding the cutting tool along a cut surface.

11. The method according to claim 1, wherein the length of the primary incision is less than thirteen (13) centimeters.

12. The method according to claim 1, wherein the length of the primary incision is less than seven (7) centimeters.

13. The method according to claim 1, further comprising making a secondary incision near the knee joint of the leg, the secondary incision having a length less than the length of the primary incision, wherein both of the primary and secondary incisions are sized or located such that a quadriceps mechanism in the leg of the patient is preserved.

14. The method according to claim 13, further comprising the step of moving an imaging device through the secondary incision.

15. The method of claim 1, wherein the incision is made over a collateral ligament.

16. The method of claim 1, wherein the patella is moved to a lateral side of its normal position, with the inner side of the patella facing inward toward the distal end portion of the femur.

17. The method of claim 1, wherein the incision is formed in an approach selected from the group consisting of:

mid vastus, sub vastus.

18. The method of claim 1, wherein the patella is elevated, while maintaining the patellar articulating surface facing the trochlear groove, using a technique selected from the group consisting of:

inflatable retraction, fluid retraction, mechanical retraction.

19. The method of claim 1, further including:

carrying out the method while preserving the cruciate ligaments.

20. The method of claim 1, further including:

positioning a polymeric cutting guide in alignment with the femur;

wherein said steps of resecting are performed using the cutting guide.

21. The method of claim 1, wherein said steps of resecting are performed using computer navigation.

22. The method of claim 1, wherein the medial and lateral condyles and the trochlear groove are resected to create a first anterior femoral cut surface forming a flat planar configuration, and further including:

resecting the distal and posterior surfaces of the distal femur to create second and third femoral cut surfaces, each forming flat planar configurations; and

resecting two chamfer surfaces, a first chamfer surface between the anterior and distal cut surfaces, and a second chamfer surface between the posterior and distal cut surfaces, to form fourth and fifth cut surfaces, each forming flat planar configurations.

23. A method of performing surgery on a knee portion of a patient wherein the quadriceps mechanism in the leg of the patient is preserved throughout the method, comprising:

making a single primary incision at or near the knee portion, the primary incision located offset from a midline of the patella;

displacing the patella medially or laterally of its normal position while maintaining the articulating surface of the patella facing the trochlear groove;

resecting a surface of the medial and lateral condyles and the trochlear groove of the femur of the leg, to create a femoral cut surface;

resecting the proximal tibial surface;

affixing a knee implant operative to replace the resected articular surfaces of the femur, the implant comprising not more than three articulating surface portions, to the cut surfaces.

24. The method according to claim 23, wherein the incision is less than thirteen (13) centimeters.

25. The method according to claim 24, further comprising the step of moving a cutting instrument through the incision.

26. The method according to claim 25, wherein the incision is made when the knee joint of the leg is flexed.

27. The method according to claim 26, wherein a lower portion of the leg is suspended relative to an upper portion of the leg.

28. The method according to claim 27, further comprising the step of resecting a portion of the patella to create a patellar cut surface, moving a patellar component of the knee implant through the primary incision, and positioning the patellar component with respect to the patellar cut surface.

29. The method according to claim 28, wherein the step of resecting the patella is performed before resecting the tibia and femur.

30. The method of claim 23, further including positioning a cutting guide having a guide surface offset from a central axis of a bone to be cut, wherein said step of resecting a surface of the medial and lateral condyles or said step of resecting a surface of the trochlear groove includes using the guide surface of the positioned cutting guide to guide a cutting instrument.

31. The method of claim 30, wherein said cutting guide is positioned using preoperative image of the bone to be cut.

32. The method of claim 30, wherein using the guide surface includes guiding the cutting instrument within a slot of the cutting guide.

33. The method of claim 23, wherein the incision is formed in an approach selected from the group consisting of:

mid vastus, sub vastus.

34. The method of claim 23, further including:

carrying out the method while preserving the cruciate ligaments.

35. The method of claim 23, further including:

positioning a polymeric cutting guide in alignment with the femur;

wherein said steps of resecting are performed using the cutting guide.

36. A method of performing knee arthroplasty which reduces damage and disruption of the quadriceps mechanism, comprising:

performing knee arthroplasty at least two times, at intervals of more than one year, each knee arthroplasty including

(a) making a single primary incision, of not more than 13 centimeters in length, near the knee joint of a leg of a patient, the incision sized or located such that a quadriceps mechanism in the leg of the patient is preserved, the primary incision located laterally of the patella;

(b) resecting a surface of at least one, but not every one, of the medial condyle, the lateral condyle, the trochlear groove, and the patella;

(c) moving at least one knee replacement component through the primary incision, without damage and disruption of the quadriceps mechanism, each of said at least one component having an articulating surface operative to replace substantially the entire articulating surface of at least one of the resected surfaces;

(d) positioning the at least one component with respect to the resected surfaces.